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Instructions for Filing an Application with the DEQ Environmental Laboratory Accreditation Program This page last updated: 09/09/2003 Purpose: This application form provides a means for environmental laboratories to apply for accreditation to submit environmental laboratory data as required by LAC 33:I.Subpart 3. The application form also provides the information needed to assess fees for the parameters a laboratory is accredited to perform. Explanation and Definition: The "Application for Environmental Laboratory Accreditation" is to be completed by environmental laboratories applying for certification in accordance with LAC 33.I.Subpart 3. The completed application form, attachments, and enclosures, with the required $660.00 application fee, are to be submitted to the Louisiana Department of Environmental Quality, Environmental Laboratory Accreditation Program. "Section by Section Instructions": Section A. Purpose of Application: Check the blank that identifies whether the laboratory is applying for initial accreditation, renewal accreditation, reaccreditation, or accreditation for additional parameters. Section B. Type of Accreditation: Check the blank that identifies whether the laboratory is seeking accreditation to operate only in Louisiana or in multiple states. Section C. Laboratory Name: Enter your laboratory's official or legal name. If your lab is a branch office or a substation of the Company, specify the location or the branch name after a dash. Limit name to 27 characters (including punctuation and spaces) for computer entry. Section D. Mailing Address: Enter the complete mailing address of the office where correspondence should be sent (i.e., P. O. Box). Also, if the lab is located in Louisiana, enter the parish code referencing the attached list of parish codes. Section E. Shipping Address: Enter the street address of your laboratory (not P. O. Box). If no street address has been assigned, enter a location or description. Also, if the lab is located in Louisiana, enter the parish code referencing the attached list of parish codes. Section F. Billing Name and Address: Enter the name and complete address of the office where the invoice for fees should be sent. Also, if the lab is located in Louisiana, enter the parish code referencing the attached list of parish codes. Section G. Laboratory Telephone Number: Enter your laboratory's business telephone number. Section H. Laboratory FAX Number: Enter your laboratory's telefax machine number if one is available. Section I. Laboratory Internet E-Mail Address: Enter the internet e-mail address for your laboratory if one is available. Section J. Type of Laboratory: Check the type of laboratory which applies. Section K. Laboratory Representative as defined in LAC 33:I.4503: Enter the name and telephone number for the Laboratory Representative. Section L. Out-of-State Laboratories Only: This Section applies to out-of-state laboratories only. List all Environmental Laboratory Accreditations/Certifications held by the laboratory. Attach copies of all current Accreditations/Certificates, including lists of parameters and methods, last two EPA WS and/or WP PE study results, most recent on-site evaluation reports and responses to deviations from each of the following State Accreditation/Certification Programs (Use additional sheets if necessary.). Section M. Laboratory Technical Director: Enter the name, telephone number, education, and related experience for that person designated as Laboratory Technical Director. Section N. Laboratory Personnel: Enter the name, education, experience, and primary responsibilities for all key personnel involved in the laboratory operations. Resumes may be attached. Section O. Test Categories, Fields of Testing, and Fee Calculation: EXAMPLE OF FEE CALCULATION: FIELDS OF TESTING TEST CATEGORIES Air Emission X Metals Air Pollutants Including Industrial Hygiene and Toxic Organic Compounds (T.O.) Methods Nutrients, Minerals, Ion, Demands, Classical Wet Chemistry, Total & Fecal Coliforms Wastewater/ Surface Water X X Ground Water Solid and Hazardous Waste Soils, Sediments, and Sludges X X X Biological Materials Radiological/ Assays Bioassays/ Biomonitoring/ Toxiological Annual Fee per Category Your Fees $330 $330 $330 $330 $330 $330 Microbiology Including Fecal & Total Coliform $330 Bioassay / Biomonitoring $330 Organics Including Volatiles, SemiVolatiles, Pesticides, Herbicides, and PCBs X Dioxins and Furans X X X X $330 $330 $330 $330 Radiochemistry Asbestos $330 X $330 Geotechnical Soil Testing $330 Minor Conventional Parameters (BOD5, O&G, TSS, Fecal & Total Coliform, Residual Chlorine Only)* $264 *Do not check this category if you checked any other category. This category is for laboratories seeking accreditation for these parameters only. Total Test Category Annual Fee $ 1980 TOTAL ANNUAL FEE CALCULATION Total Test Category Annual Fee (From above) Annual Surveillance and Evaluation Fee (ASEF) Category above. $ 1980 Add $330 if you checked only one Test $330 $0 Total Annual Fee for Your Laboratory Total Test Category Annual Fee + ASEF (if applicable) $ 1980 Section P. Clean Water Act Methodology: Circle the approved method(s) for each Clean Water Act parameter that the laboratory is seeking accreditation to perform. Laboratories applying for accreditation must use EPA-approved methodologies or other methods specifically approved by DEQ. If the laboratory is seeking accreditation for additional methods not listed in a table in this Section, the parameter, method, and other necessary information (including the page number of the corresponding table) should be listed in the Miscellaneous Methodologies Table in Section V. For out-of-state laboratories, if a parameter is not listed on their accreditation/certificate by their State Accrediting/Certifying Authority, approval cannot be issued by the Louisiana Environmental Laboratory Accreditation Program. Organic parameters must be listed by method and analyte in Section V. Section Q. Solid and Hazardous Waste Methodology: Circle the approved method(s) for each Solid and Hazardous Waste parameter that the laboratory is seeking accreditation to perform. Laboratories applying for accreditation must use EPAapproved methodologies or other methods specifically approved by DEQ. If the laboratory is seeking accreditation for additional methods not listed in a table in this Section, the parameter, method, and other necessary information (including the page number of the corresponding table) should be listed in the Miscellaneous Methodologies Table in Section V. For out-of-state laboratories, if a parameter is not listed on their accreditation/certificate by their State Accrediting/Certifying Authority, approval cannot be issued by the Louisiana Environmental Laboratory Accreditation Program. Organic parameters must be listed by method and analyte in Section V. Section R. Shellfish Waters and Meats Methodology: Circle the approved method(s) for each Shellfish Waters and Meats parameter that the laboratory is seeking accreditation to perform. Laboratories applying for accreditation must use EPAapproved methodologies or other methods specifically approved by DEQ. If the laboratory is seeking accreditation for additional methods not listed in a table in this Section, the parameter, method, and other necessary information (including the page number of the corresponding table) should be listed in the Miscellaneous Methodologies Table in Section V. For out-of-state laboratories, if a parameter is not listed on their accreditation/certificate by their State Accrediting/Certifying Authority, approval cannot be issued by the Louisiana Environmental Laboratory Accreditation Program. Section S. Other Plant and Animal Tissue Methodologies: Write in the approved method(s) for each plant and animal tissue parameter that the laboratory is seeking accreditation to perform. Laboratories applying for accreditation must use EPAapproved methodologies or other methods specifically approved by DEQ. For out-of-state laboratories, if a parameter is not listed on their accreditation/certificate by their State Accrediting/Certifying Authority, approval cannot be issued by the Louisiana Environmental Laboratory Accreditation Program. Section T. Clean Air Act Methodology: Circle only the approved method(s) that the laboratory is seeking accreditation to perform. Out-of-state laboratories: The states certifying Authority’s certificate must reflect the appropriate certification for each method circled. NIOSH & OSHA Methods: In the space below, write in the number of the NIOSH or OSHA method that the laboratory is seeking accreditation to perform. Other EPA Methods: In the space below, write in the number of the EPAapproved methods the laboratory is seeking accreditation to perform. (Examples: EPA 15; EPA 23; EPA 114; R-1 to R-64). If the laboratory is seeking accreditation for additional methods not listed in a table in this Section, the parameter, method, and other necessary information (including the page number of the corresponding table) should be listed in the Miscellaneous Methodologies Table in Section V. Section U. Radiological Methodology and Equipment: Circle the approved method(s) for each radiological parameter that the laboratory is seeking accreditation to perform. Laboratories applying for accreditation must use EPA-approved methodologies or other methods specifically approved by DEQ. For out-of-state laboratories, if a parameter is not listed on their accreditation/certificate by their State Accrediting/Certifying Authority, approval cannot be issued by the Louisiana Environmental Laboratory Accreditation Program. Write in the required information regarding laboratory instrumentation. Section V. Miscellaneous Methodologies: Write in approved parameters and methods for which the laboratory seeks accreditation which are not found in previous Sections in the application. This includes additional methods corresponding to parameters listed in the tables in previous Sections in the application and also parameters and methods that do not fit in any of the tables in previous Sections in the application. Section W. Quality Control: Check the quality control practices used by your laboratory with the frequency they are performed. If a Section does not pertain to your laboratory, include "NA" in the comment section. The laboratory's quality assurance plan and a list of standard operating procedures must be submitted with the completed application package. Section X. Statement of Validation: The application must be signed and dated by the Laboratory Representative attesting to the validity of the information documented in the application. Section Y. Designation of Laboratory Representative: The Laboratory Representative must be designated by the laboratory's governing body (owners, directors, commissioners, councilmen, mayor, board members, or whosoever occupies the status of proprietor). Section Z. Attestation of Compliance Form: Complete the form with the appropriate signatures and return it with your application. NOTE: APPLICATION MUST BE TYPED. THE SHADED AREAS ON THE APPLICATION ARE FOR OFFICE USE ONLY. PLEASE DO NOT MARK IN THESE AREAS. Office Mechanics and Filing: One copy of the application form needs to be completed. The completed application form and a copy of the application form, along with the application fee, attachments, and enclosures need to be routed to the Louisiana Department of Environmental Quality, Environmental Laboratory Accreditation Program. The mailing and shipping address appear below: Mailing Address: Louisiana Department of Environmental Quality Office of Management and Finance Environmental Laboratory Accreditation Program P. O. Box 82231 Baton Rouge, LA 70884-2231 Shipping Address: Louisiana Department of Environmental Quality Office of Management and Finance Environmental Laboratory Accreditation Program 7290 Bluebonnet Baton Rouge, LA 70810 Please retain a copy of your completed application form in your file for future reference. If you have any questions concerning the application form or the Environmental Laboratory Accreditation Program, please call (225)765-0582. PARISH CODES AND FIPS CODES PARISH CODES Parish Parish Code Parish Parish Code Acadia 001 Madison 065 Allen 003 Morehouse 067 Ascension 005 Natchitoches 069 Assumption 007 Orleans 071 Avoyelles 009 Ouachita 073 Beauregard 011 Plaquemine 075 Bienville 013 Pointe Coupee 077 Bossier 015 Rapides 079 Caddo 017 Red River 081 Calcasieu 019 Richland 083 Caldwell 021 Sabine 085 Cameron 023 St Bernard 087 Catahoula 025 St Charles 089 Claiborne 027 St Helena 091 Concordia 029 St James 093 DeSoto 031 St John the Baptist 095 East Baton Rouge 033 St Landry 097 East Carroll 035 St Martin 099 East Feliciana 037 St Mary 101 Evangeline 039 St Tammany 103 Franklin 041 Tangipahoa 105 Grant 043 Tensas 107 Iberia 045 Terrebonne 109 Iberville 047 Union 111 Jackson 049 Vermilion 113 Jefferson 051 Vernon 115 Jefferson Davis 053 Washington 117 Lafayette 055 Webster 119 Lafourche 057 West Baton Rouge 121 La Salle 059 West Carroll 123 Lincoln 061 West Feliciana 125 Livingston 063 Winn 127 FIPS CODES Table 1: FIPS State Codes for the States and the District of Columbia Name Alabama FIPS State Numeric Code FIPS State Alpha Code 01 AL Name Missouri FIPS State Numeric Code FIPS State Alpha Code 29 MO Alaska 02 AK Montana 30 MT Arizona 04 AZ Nebraska 31 NE Arkansas 05 AR Nevada 32 NV California 06 CA New Hampshire 33 NH Colorado 08 CO New Jersey 34 NJ Connecticut 09 CT New Mexico 35 NM Delaware 10 DE New York 36 NY District of Columbia 11 DC North Carolina 37 NC Florida 12 FL North Dakota 38 ND Georgia 13 GA Ohio 39 OH Hawaii 15 HI Oklahoma 40 OK Idaho 16 ID Oregon 41 OR Illinois 17 IL Pennsylvania 42 PA Indiana 18 IN Rhode Island 44 RI Iowa 19 IA South Carolina 45 SC Kansas 20 KS South Dakota 46 SD Kentucky 21 KY Tennessee 47 TN Louisiana 22 LA Texas 48 TX Maine 23 ME Utah 49 UT Maryland 24 MD Vermont 50 VT Massachusetts 25 MA Virginia 51 VA Michigan 26 MI Washington 53 WA Minnesota 27 MN West Virginia 54 WV Mississippi 28 MS Wisconsin 55 WI Wyoming 56 WY Table 2: FIPS State Codes for the Outlying Areas of the United States, the Freely Associated States, and Trust Territory Area Name FIPS State Numeric Code FIPS State Alpha Code Status American Samoa 60 AS 1 Federated States of Micronesia 64 FM 3 Guam 66 GU Marshall Islands 68 MH Northern Mariana Islands 69 MP Palau 70 PW 4 Puerto Rico 72 PR 1 U.S. Minor Outlying Islands 74 UM 2 Virgin Islands of the U.S. 78 VI 1 3 Status: 1. 2. 3. 4. Under U.S. sovereignty An aggregation of nine U.S. territories: Baker Island, Howland Island, Jarvis Island, Johnston Atoll, Kingman Reef, Midway Islands, Navassa Island, Palmyra Atoll, and Wake Island. Each territory is assigned a FIPS County Code in FIPS PUB 6-3, and may be individually identified through a combination of the FIPS State Code (74 or UM) and the appropriate FIPS County Code. A Compact of Free Association with the United States of America is now in full force. It was announced by Presidential proclamation on November 3, 1986. Remains a trust territory. Table 3: FIPS State Numeric Codes for the Individual Minor Outlying Island Territories Area Name FIPS State Numeric Code Baker Island 81 Howland Island 84 Jarvis 86 Johnston Atoll 67 Kingman Reef 89 Midway Islands 71 Navassa Island 76 Palmyra Atoll 95 Wake Island 79 FIPS PUB 5-2 CHANGES REQUEST FORM TO FIPS PUB5-2 CODES FOR THE IDENTIFICATION OF THE STATES, THE DISTRICT OF COLUMBIA AND THE OUTLYING AREAS OF THE UNITED STATES, AND ASSOCIATED AREAS Institute for Computer Science and Technology Technology Building, Room B-14 National Bureau of Standards